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This is not the official website for HealthCare.Gov, but as a Certified Agent with FFM HealthCare.gov I can answer your questions.  Please visit http://www.healthcare.gov for complete information and coverage options.
Serving Clients in the following Counties and Cities.  This is not a complete list, as we help all clients in Oregon

Hood River


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Key Websites


Cover Oregon

Breaking News



OregonACA.com Affordable Health Care Act

"A Real Person Will Answer"  Call 503-922-2903

Health Benefits Solution, Inc

Doug Ellsworth, NPR Certified Agent #7139388

Email: Doug@OregonACA.com

Nancy Taylor, NPR Certified Agent # 7435825

"Start Here"

Apply Now 2015 Health Plans

Health Insurance Companies "Direct"

2015 Plans

STM Short Term Medical "LifeMap"

STM Short Term Medical "HCC"

IMG International Travel Insurance

IMG Coverage Brochure

Cover Oregon will still be the official site for enrolling in the Oregon Health Plan, OHP

Please visit this site for Application and Current Information


Small Business Tax Credit Information 2015

Help Me Set Up Obama Care Health Insurance in Oregon

Starting November 15th, 2014 I will have access to help enroll clients through the  HealthCare.Gov Portal.  As a Certified Agent I can answer questions, and show you the plan options and rates which will go effective January 1st, 2015.  If you would like my help just click the above link and I will give you a call and answer questions you have.  My time and services are free and I am available 9:00 am to 8:00 pm 7 days a week.

Between Jobs, or Unemployed!  Offered Cobra Health Insurance and cannot afford the premiums?  The are many Low Cost, and Affordable options.  All coverage is with Major Health Insurance Companies and a "Real Person" will answer the phone to help you!

The focus of this website is to provide consumers a simple, and professional environment when looking for Affordable, and Low Cost Health Insurance.  Licensed Health Insurance Agents are available and will take the time to answer all your questions, and help find the Health Plan that best meets your needs

Health Insurance Benefits are always changing, and health insurance companies are providing more options that benefit the consumer.  Alternative, or Holistic health care is now offered through many of the health insurance companies.  You can now see your Naturopathic Physician, and be covered under the doctor office co-pay, and have unlimited visits.  Chiropractic, and Acupuncture are also included as standard health care benefits with many companies.

If you are looking for Low Cost and Affordable Dental and Vision benefits included within the health plan, we can help you select the Health Insurance Company that will meet your needs.

Health Benefit Solution, Inc is licensed through the Oregon Insurance Division, and has contracted with most all the major health insurance companies to provide the consumer with choice and options when looking for the plan that meets the life style and needs of the insured.

Health Benefits Solution, Inc is a leader in offering Company Direct Health insurance coverage for all individuals, and small business in Oregon.  The Affordable Care Act and HealthCare.gov will offer affordable health insurance options to all Oregonians with or without tax credits or CSR "Cost Sharing Reductions".  The Oregon Health Plan will still be offered through CoverOregon.com

Cover Oregon Small Business Health Care Tax Credit

Qualifying employers can take advantage of the IRS Small Business Health Care Tax Credit, even
though Cover Oregon cannot yet serve small businesses. Cover Oregon and participating insurance
companies worked together to make this possible.
Beginning April 1, 2014, when an employer purchases or renews a Cover Oregon-certified medical
or dental plan directly from a participating insurance company, Cover Oregon will confirm their
eligibility to shop within Cover Oregon and provide an Eligibility Notice. An employer may be
eligible for the small business tax credit if all of the following criteria are met:
• Employ fewer than 25 full-time equivalent employees (FTEs);
• Pay average annual wages of less than $50,000 per full-time-equivalent employee per year;
• Pay at least 50% of the premium cost of qualified employee-only health insurance coverage for
their employees);
• Purchase in one or more Cover Oregon-certified medical and/or dental plans directly with an
insurance company.
Steps to apply for the Small Business Health Care Tax Credit
*Cover Oregon does not determine eligibility for the Small Business Tax Credit.
Consult your tax professional for more information or visit irs.gov and select “Credits & Deductions”.

Oregon health insurance exchange

Cover Oregon successfully transitioning to Healthcare.gov partnership

Successfully transitioning to HealthCare.gov

Following months of efforts to fix the troubled website, Cover Oregon’s board voted on April 25 to switch to using Healthcare.gov rather than continue to try to repair the existing site.  The Cover Oregon website will still exist, but will redirect visitors to Healthcare.gov.

The supported state based marketplace (SSBM) model means that Cover Oregon will be working together with HHS, with the state retaining some functions and HealthCare.gov being utilized to enroll people in private plans through the exchange.  Tina Edlund, Director of the Oregon Health Agency, was selected in early May to lead the transition.

At a board meeting on October 9, Cover Oregon provided a detailed update on the exchange’s transition to HealthCare.gov – which appears to be going very well more than a month ahead of open enrollment.  All 15 carriers offering plans in the exchange have been added to the HealthCare.gov system, and testing between the carriers and HealthCare.gov began on October 9.

Cover Oregon is working together with CMS to create “learning pages” that will be hosted on HealthCare.gov and will help prepare Oregon residents for the upcoming open enrollment period.

The exchange will be utilizing three separate websites during open enrollment, but they will be interoperable.  HealthCare.gov will be the main enrollment platform for people applying for private plans and for income-based Medicaid.  CoverOregon.com will be available to help people find local in-person assistance with enrollment.  In addition, OregonHealthcare.gov will help applicants who are eligible for Medicaid for reasons other than income (disability, pregnancy, etc.).

Enrolling and re-enrolling for 2015

All 2014 policies that were purchased through Cover Oregon will terminate on December 31, 2014.  Open enrollment begins on November 15 and ends on February 15.  But in order to have seamless coverage, with a new plan taking effect January 1, current enrollees must re-enroll through HealthCare.gov between November 15 and December 15.

In addition to the existing policy-holders who will need to re-enroll, new applicants will also be able to obtain coverage during open enrollment.  To have a policy in place on January 1, the enrollment must be completed by December 15.

Oregon has completed the rate review process for 2015.  So although enrollment and 2015 rates will not be available on Healthcare.gov until November 15, Oregon residents can visit oregonhealthrates.org to see detailed information about the rate review process and the average rates for 2015.

Although Healthcare.gov will be handling Oregon’s private plan enrollments for 2015, Cover Oregon will still be involved in Oregon Health Plan Medicaid enrollment.  The exchange confirmed in mid-August that the online application for Oregon Health Plan will be more streamlined and the eligibility determination process will be completely automated by 2015.  But there are still some doubts as to whether the entire process for seamless Medicaid enrollment will be up and running by November.

2014 progress despite challenges

Although the Cover Oregon website has been largely regarded as a technological disaster, things should be much better during the 2015 open enrollment period, when enrollments will be processed through Healthcare.gov.  Despite myriad technological problems, Cover Oregon had still enrolled just over 100,000 people in private plans by August 25 (only about 79,000 of those policies are still active, the rest either didn’t pay their premiums or have cancelled their coverage at some point during the year; significant attrition is always expected in the individual insurance market). Of the private plan enrollees, roughly 53 percent were uninsured prior to obtaining a policy through Cover Oregon.

Oregon expanded Medicaid under the ACA, and 330,000 people had enrolled in Medicaid by June (Oregon Health Plan), the majority of them completing their Medicaid enrollment via Cover Oregon.  From June 2013 to June 2014, Medicaid enrollment in Oregon increased by 58 percent – from about 614,000 people to about 976,000.

Despite the tremendous technological difficulties experienced by the exchange, Oregon had the seventh highest drop in uninsured rate during the first half of 2014 according to a recent Gallup poll.  The state’s uninsured rate was 19.4 percent in 2013, and had fallen to 14 percent by mid-2014.

Turning around a failed exchange

Cover Oregon will be switching to a SSBM by the start of the 2015 open enrollment period, but the exchange is still working to repair itself.  In mid-June, Cover Oregon announced that they had selected a new executive director, Aaron Patnode.  The hiring of Patnode, who was previously a Kaiser Permanente manager, indicates that the exchange is still thinking long-term, and Patnode’s reputation as a problem solver and “turn-around artist” bodes well for the long-term success of the exchange in a partnership with HHS, or possibly as a fully state-run marketplace in 2016 or beyond.

In addition to Patnode, the state also hired “corporate turnaround expert” Clyde Hamstreet earlier this year in an effort to right the failed exchange.  Hamstreet and two assistants worked throughout the summer and the exchange has spent upwards of $600,000 on their services so far.

Uncovering what went wrong

The FBI and federal prosecutors have launched investigations into the failed exchange – which cost $248 million in tax dollars and was never able to enroll applicants entirely online.  In early June, Governor John Kitzhaber asked Oregon Attorney General Ellen Rosenblum to take legal action against Oracle – the creator of the Cover Oregon website – in order to recover funds spent on the site.

But Oracle is fighting back, saying that officials at Cover Oregon and Oregon Health Authority are to blame for the debacle.  Both sides have sued each other, and the issue was still highly contentious by late August.

On February 18, four and a half months after open enrollment began, Cover Oregon’s website was finally functional enough for insurance agents and navigators to be able to process enrollments start to finish online.  Although the site was never fully functional for the general public to complete the entire enrollment process online, the availability of some electronic enrollment was a huge improvement after months of relying solely on paper applications.

Despite the fact that Cover Oregon was the only exchange relying solely on paper applications for the first four months of open enrollment, its total enrollment numbers are around the middle of the road when compared with enrollment in other states – all of which were using much more efficient online applications for months.

Grandmothered plans can be renewed

Virtually all of the existing 2013 individual policies in Oregon were eligible for renewal into 2014.  Moda Health Plan Inc. and PacificSource Health Plans allowed existing policies to extend until the end of March.  And seven carriers allowed 2013 policies to be renewed until the end of 2014: Regence BlueCross BlueShield of Oregon, Kaiser Foundation Health Plan of the Northwest, Providence Health Plan, LifeWise Health Plan of Oregon, Health Net Health Plan of Oregon Inc., Time Insurance Co. and John Alden Life Insurance Co.

The renewal of 2013 plans into 2014 gave many Oregon residents in the individual market some breathing room as they waited for Cover Oregon’s website to improve.

Oregon is also permitting those pre-2014 plans to be renewed again this fall and remain in force throughout 2015, at each carrier’s discretion.

Exchange worked to cover risk pool members

The Oregon Medical Insurance Pool – a state run high risk pool – closed at the end of December, but the state implemented a temporary medical insurance program that automatically covered risk pool members who were not able to enroll in an exchange plan with a January 1 effective date.

The temporary plan remained in force until March 31, but ceased operation at that point.  Insureds who were still covered under the temporary program lost their coverage at the end of March, but the risk pool had been working closely with members to get them transitioned to new policies, so there were very few people still on the temporary program at that point.

Cover Oregon’s history

The Oregon legislature authorized a state-run health insurance exchange in 2011, and the exchange developed a formal business plan, which the Legislature approved in February 2012 as a final go-ahead for the exchange. The U.S. Department of Health and Human Services (HHS) gave conditional approval to Cover Oregon in December 2012. The exchange has a 2014 budget of $105.7 million, which will be covered with federal grant money, and $62.4 million budget in 2015 according to a Cover Oregon spokesperson.

Cover Oregon is overseen by a nine-member board of directors, two of which are non-voting members. The board receives input from the Individual and Employer Consumer Advisory Committee. The 19-member committee holds monthly meetings, which are open to the public. The Consumer Advisory Committee was mandated by the legislation that established the state’s exchange.

Committee members are selected by the board and must include individuals or employers who will use the exchange, individuals who will enroll in state medical assistance through the exchange, minority groups, and representatives of organizations that will people purchase insurance through the exchange. All geographic areas of the state must be represented.

Cover Oregon is acting as “active purchaser,” meaning it limits the number of health insurers that can participate in the exchange. Participating insurers are required to offer a bronze, silver and gold plan and have the option to offer additional plans.

Contact the Oregon exchange

Cover Oregon
855-CoverOR (855-268-3767)

More Oregon health insurance exchange links

State Exchange Profile: Oregon
The Henry J. Kaiser Family Foundation overview of Oregon’s progress toward creating a state health insurance exchange.


If you like your plan you can keep it. Under ObamaCare you can keep your health insurance until 2015, even if it doesn't comply with the ACA. Come 2015, if your plan doesn't have a grandfathered status and doesn't meet the requirements of the ACA, then you will have to choose a new plan. Let's look a little deeper into the details you need to know about keeping your plan.

SPECIAL UPDATE: You can now keep your plan until 2017 in some states!

The Department of Health and Human Services (HHS, i.e. the department in charge of ObamaCare) has announced that health insurance plans that were supposed to be canceled by Obamacare by 2014 may be sold through October of 2016 in states that approve of the extension. This essentially extends some non-compliant non-grandfathered plans until 2017 (a plan renewed in 2016 is good for one year, the latest date to renew your plan is October 2016).

Americans Can Now Keep Their Plans Until 2015

The Affordable Care Act contains provisions that state that health plans that don't have a grandfathered status and don't comply with the ACA need to be changed by 2014. After a lot of controversy and millions of Americans facing losing their health insurance for 2014, the President announced a fix that allows for insurance companies to reinstate health plans that were canceled until 2015 and has allowed insurance companies to renew other non-compliant health plans until 2015 as well.

However, insurance companies must tell policy holders that their plans do not meet the new minimum standards and must inform them about other options on the new marketplaces, including the availability of subsidies to help them pay their insurance costs.

This move will allow Americans to shop around on the exchanges and see if their is a better option for them and their family while still allowing them to keep their current health plan, regardless of if it meets the new standards of the Affordable Care Act.

All new plans sold in 2014 still have to comply with the ACA.

Can I Keep My Current Health Plan Overview?

Private health plans, including employer group health plans, that don't meet the standards of the Affordable Care Act and don't have a grandfathered status may have to be switched to health plans that do. You can keep your current health plan after 2015 if:

• Some States with working health insurance marketplaces, like Washington State, have rejected the "fix" to let people to keep health insurance plans that would be canceled under the Affordable Care Act . Your insurance company will be able to confirm whether you can keep your plan, or buy a non-compliant plan in your State.

• Your private plan has grandfathered status and remains unchanged by the provider.

• You have a non-grandfathered private plan that meets the requirements of the Affordable Care Act (listed below).

• You have Medicare, Medicaid, TRICARE or another form of Public health care.

You may have to switch to a new health plan if:

• Your plan doesn't have, or loses, grandfathered status and doesn't meet the requirements of the ACA.

Learn more about ObamaCare and Grandfathered Status.

Why Can't I Keep My Health Insurance?

Everyone is required to have insurance for 2014, allowing some to keep their plans and others to buy new plans with more coverage will unbalance the cost of premiums. It creates two separate pools of healthy and sick people.

The healthy people would be more likely to stick with the old plans, which cost less and offer less coverage because they don’t expect to need it. Meanwhile, sick people would buy the more expensive, comprehensive plans.

The point of discontinuing plans that didn't provide adequate coverage was to ensure that if everyone had to have coverage then they would all have to be part of the same risk pool, ensuring that prices were at their most affordable for everyone.

Below are some of the benefits of new insurance plans that plans that face or will face cancellation don't have to adhere to.

The Truth Behind, "If You Like Your Plan You Can Keep it"

A common talking point of supporters of the Affordable Care Act was, "if you like your plan you can keep it." Like many other talking points this is only a half truth. The quote should be, "If you have a non-grandfathered plan that meets the requirements of the ACA, you can keep it. Also if you have a grandfathered health plan that doesn't meet the requirements of the ACA you can keep it as long as the benefits remain relativity unchanged. However, most grandfathered plans will change and will require people on those plans to move to a new plan that does meet the requirements of the ACA."

In order for a plan to be in danger of cancellation it is most likely not offering at least one of these new mandatory benefits, rights, and protections:

1. A Ban on denied treatment or coverage for preexisting conditions. You can't be denied or dropped from coverage for being sick.

2. Ten Essential Health Benefits. Essential Health Benefits have no annual or lifetime dollar limits.

3. A Ban on rescission of health insurance coverage and the right to an appeal. You can't be dropped for any reason other than fraud and if you are dropped you have the right to a quick internal and external appeal.

4. Ban on Discrimination based on gender or health. You can no longer be charged more for being a woman.

5. Ban on all lifetime limits and $2,000,000 Cap on annual limits. You are more protected from bankruptcy due to costly medical expenses.

6. Free Preventive Services and Wellness Visits.

Can I Keep My Current Non-Grandfathered Plan?

If your plan doesn't meet the standards of the Affordable Care Act and it's not protected by its grandfathered status then your insurance company will either issue you a new plan or cancel your current plan and let you know other plan options available to you. In some cases your insurer will notify you by mail, in other cases they will provide more assistance. While this can be a pain, the new plan you get will offer the new benefits, rights, and protections guaranteed by the Affordable Care Act.

Will a New Plan Cost Me More?

In some cases new plans will have better protections for a higher cost and in some cases families will get a cheaper plan with better benefits. The important thing to realize is that no matter how good your premium prices, cost sharing, or network was on your old plan it didn't have the same rights and protections of newer plans. Also note that if you make under 400% of the Federal Poverty Level in 2014 you will have access to cost assistance through the health insurance marketplace. In most cases you can find an equivalent plan to what you have now through your current insurer or the marketplace.

The Dangers of Keeping an Old Health Care Plan

Please be aware that health insurance plans are being dropped for a reason in many cases. Some older plans don't offer reasonable coverage, or can drop you when you get sick, or deny you treatment when you need it most. Annual and lifetime limits on your care can led to bankruptcy and many plans can currently charge women significantly more than men. Make sure you understand what rights and protections your plan offers.

Also make sure that you check out your State's health insurance marketplace and see if you qualify for cost assistance.

The Benefits Of Keeping Your Old Health Care Plan

For some Americans they will want to keep their old health insurance policy as long as possible. If your plan has a grandfathered status you are safe, if it doesn't you'll be able to keep it until 2015. Older grandfathered plans don't have to comply with the new law and for some this means they will be able to get lower rates and also get the care they need. See our page on grandfathered health plans for more "benefits of grandfathered plans".

At the end of the day we suggest that everyone take 2014 to apply for their State's health insurance marketplace and to see what their options are. This way when 2015 rolls around there will be far less confusion as to what your health insurance options are. Learn more about Grandfathered Health Plans (the plans you CAN keep) and the Health Insurance Marketplace (where you go to get a new plan that complies with the ACA).


People who enrolled in Oregon's troubled health insurance exchange will have to re-enroll for coverage, as Cover Oregon transitions to the federal government.

Tina Edlund of the Cover Oregon Transition Project told the Oregon Health Policy Board this week that come November, about 80,000 Oregonians will have to log on to healthcare.gov to get their insurance.

"No matter what, people were going to have to go back. Even if they'd just stayed with Cover Oregon, they were going to have to go back and update information," Edlund said.

"You know, changes in your family, changes in your income. All of that and just like all of us have to go with our employer sponsored insurance and make up dates on an annual basis. Some of this was going to have to happen anyway."

Related: Director confident in Cover Oregon's latest project

Edlund said her main goal is for Oregonians to have a working website in which to enroll starting Nov. 15.

About 422,000 Oregonians enrolled in new health care this year — that ranked the state seventh out of the 15 states that launched their own websites.

The Cover Oregon website never worked as it was meant to, and the board decided in April to move to the federal government site.

Additionally, details on how the Affordable Care Act is changing Oregon's health insurance market place are beginning to emerge.

New figures from the Oregon Health Policy Board show fewer people are self-insuring. Many appear to have signed-up for state-regulated individual insurance instead.

About 330,000 people have been added onto the Oregon Health Plan.

But it's only the second time these quarterly policy board numbers have been released.

Gretchen Morley is the director of health analytics at the Oregon Health Authority. She says it's too soon to pin-down any trends, but that's the hope.

"This kind of quarterly report will provide a source to get a sense of what we think is going on with insurance coverage in Oregon," she said Wednesday.

Last year Oregon had 550,000 uninsured people. One of the big questions is whether the Affordable Care Act has reduced that number and if so, by how much.


DURHAM, Ore. April 25th, 2014 cbsnews  Oregon gives up on state Obamacare site, switches to

 -After months of trying to get its problem-plagued online health exchange to work, Oregon on Friday officially gave up on the state portal and decided to switch to the federal website - the first state in the nation to do so.

Cover Oregon's board approved an advisory committee's recommendation to ditch its troubled portal. Oregon will use HealthCare.Gov for private policies.

·                     Study: Obamacare didn't necessarily lead to health plan cancellations

·                     38 Republican lawmakers support lawsuit to end Obamacare subsidies

Officials say fixing the existing system would be too costly at $78 million and would take too long. Switching to the federal system would cost just $4 million to $6 million.

Oregon's exchange is seen as the worst in more than a dozen states that developed their own online health insurance marketplaces. The general public still can't use Cover Oregon's website to sign up for coverage in one sitting.

Instead, Oregonians must use a time-consuming hybrid paper-online process to sign up for insurance - despite $134 million the state paid Oracle Corp. to build the online exchange. Oregon received a monthlong enrollment-deadline extension because of the technology problems.

Several other states experienced major problems with their exchanges, but only one has chosen to replace its site. Maryland recently decided to adopt the technology used on Connecticut's successful exchange.

Federal officials said the federal exchange is able to add more states, and they are working with Oregon on the next steps.

In March, the federal Government Accountability Office announced an investigation of Oregon's exchange, including looking at whether the federal government can reclaim grant money given to Cover Oregon if taxpayer funds were mismanaged.

Separately, former Health and Human Services Secretary Kathleen Sebelius asked for an inspector general's probe into problems with the rollout of the health care law.

An independent investigation ordered by Gov. John Kitzhaber found state managers repeatedly failed to heed reports about technical problems that prevented the Cover Oregon exchange from launching. It also found Oracle did a shoddy job in building the exchange. Five Oregon officials connected to the development of the Cover Oregon portal have resigned.

Kitzhaber has insisted communications about the portal's troubles never reached him as the planned Oct. 1 launch neared. The governor said he agreed with the technology advisory committee's recommendation.

Officials said they will keep the Cover Oregon website, but it will be redesigned to direct people to the federal site. Oregon also will use the federal call center, but it will retain some front-end customer outreach, education efforts and initial carrier management.

Because HealthCare.Gov enrolls people only in private health plans, Oregonians found eligible for Medicaid will be redirected to the Oregon Health Authority, a state agency that can enroll them in the Oregon Health Plan, Oregon's version of Medicaid.

So far, about 242,000 Oregonians have enrolled in coverage through Cover Oregon. About 70,000 of those enrolled in private health plans, while 172,000 enrolled in the Oregon Health Plan.






Cover Oregon

From Wikipedia, the free encyclopedia
Cover Oregon
Agency overview
Formed October 1, 2012 (2012-10-01)
Jurisdiction Health insurance marketplace for U.S. state of Oregon
Agency executive Clyde Hamstreet, Executive Director (acting)
Website http://www.coveroregon.com/

Cover Oregon is the health insurance marketplace for the U.S. state of Oregon, established as Oregon's implementation of the Patient Protection and Affordable Care Act. Cover Oregon enables Oregonians and small businesses to purchase health insurance at federally subsidized rates.

While the intent was to allow registration and selection of coverage via a website, the site has been plagued with problems and it was only possible to purchase insurance via paper registration.[1][2] As of January 2014, almost $200 million of the $300 million allocated to develop and operate the Cover Oregon website had been spent.[3]

As a result of the ongoing problems, in April 2014, the board of directors voted to close the state-run exchange and adopt the Federal HealthCare.gov exchange beginning in 2015.[4]

Health insurance exchanges were established as a part of the 2010 Patient Protection and Affordable Care Act to enable individuals to purchase health insurance in state-run marketplaces.[5] In this legislation, states could choose to establish their own health insurance exchanges; if they choose not to do so, the federal government would run one for the state.[5]

In 2011, the Oregon Legislative Assembly passed Senate Bill 99, establishing Oregon's own exchange.[6] Rocky King was named executive director of the exchange in late 2011,[7] and on October 1, 2012, the exchange was named Cover Oregon.[8]

Development of the website that would process online enrollments was done by Oracle Corporation and managed by the state of Oregon rather than an independent systems integrator.[9] The project was plagued by numerous management and technological issues, and though the website was supposed to begin processing enrollments on October 1, by mid-October, it was unable to process any enrollments.[10] As of mid-December 2013, the deadline for enrollment for coverage beginning January 1, the state had spent nearly $160 million and the site still could not process online enrollments.[9] Governor John Kitzhaber informed Oregon residents that they should obtain a paper application and mail it in to obtain coverage. The state hired or reassigned nearly 500 people to process paper applications.[11]

As of April 2014, the website was still not accepting online enrollments. 200,000 people had enrolled in Cover Oregon via paper applications, the majority through the Oregon Health Plan (Oregon's implementation of Medicaid).[1] Cover Oregon Executive Director Rocky King and Oregon Health Authority chief information officer Carolyn Lawson both resigned in the wake of the failure of the website.[2] Interim executive director Bruce Goldberg stepped down in April 2014 and was replaced by Clyde Hamstreet, a consultant who specializes in corporate turnarounds.[12]

Faced with millions to make Cover Oregon functional, the board of directors voted in April 2014 to scrap the website in favor of adopting the Federal HealthCare.gov website for 2015 enrollments.[4] Existing subscribers will have to re-enroll with the Federal exchange.[4]

Legal disputes

In August 2014, Oracle Corporation sued Cover Oregon for breach of contract,[13] and then later that month the state of Oregon sued Oracle Corporation, in a civil complaint for breach of contract and "racketeering".[14]

In 2014, 11 insurers offer plans on the individual/family market through Cover Oregon.[15]

  1. ^ Jump up to: a b Lane, Dusty (January 30, 2014). "Paging Dr. Kitzhaber: What did Gov. know about Cover Oregon collapse?". KATU.com. Retrieved February 14, 2014. 
  2. ^ Jump up to: a b "Embattled Cover Oregon director King resigns". KGW.com. January 3, 2014. Retrieved January 3, 2014. 
  3. Jump up ^ Colossal cost of Cover Oregon prompts lawmaker to call for end to spending by Chelsa Kopta Jan 20, 2014 KATU
  4. ^ Jump up to: a b c Manning, Jeff (April 25, 2014). "Cover Oregon: $248 million state exchange to be jettisoned in favor of federal system". The Oregonian. Retrieved April 27, 2014. 
  5. ^ Jump up to: a b Lewis, Nicole (July 12, 2011). "HHS Proposes Health Insurance Exchange Rules". Information Week. Retrieved November 16, 2012. 
  6. Jump up ^ "Senate Bill 99: Establishes Oregon Health Insurance Exchange Corporation as public corporation to be governed by board of directors and supervised by executive director". OregonLive.com. Retrieved November 16, 2012. 
  7. Jump up ^ Waldroupe, Amanda. "Rocky King Named Permanent Director of Oregon's Health Insurance Exchange". Lund Report. Retrieved November 16, 2012. 
  8. Jump up ^ "Oregon health insurance exchange unveils new name, website" (Press release). October 1, 2012. Retrieved November 16, 2012.


Most health plans must cover a set of preventive services like shots and screening tests at no cost to you. This includes Marketplace private insurance plans.

Free preventive services

All Marketplace plans and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.

This applies only when these services are delivered by a network provider.

  1. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
  2. Alcohol Misuse screening and counseling
  3. Aspirin use to prevent cardiovascular disease for men and women of certain ages
  4. Blood Pressure screening for all adults
  5. Cholesterol screening for adults of certain ages or at higher risk
  6. Colorectal Cancer screening for adults over 50
  7. Depression screening for adults
  8. Diabetes (Type 2) screening for adults with high blood pressure
  9. Diet counseling for adults at higher risk for chronic disease
  10. HIV screening for everyone ages 15 to 65, and other ages at increased risk
  11. Immunization vaccines for adults--doses, recommended ages, and recommended populations vary:

  12. Obesity screening and counseling for all adults

  13. Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
  14. Syphilis screening for all adults at higher risk
  15. Tobacco Use screening for all adults and cessation interventions for tobacco users


List of Ten Essential Health Benefits
  1. Ambulatory patient services (Outpatient care). Care you receive without being admitted to a hospital, such as at a doctor’s office, clinic or same-day (“outpatient”) surgery center. Also included in this category are home health services and hospice care (note: some plans may limit coverage to no more than 45 days).
  2. Emergency Services (Trips to the emergency room). Care you receive for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness. Typically, this is a trip to the emergency room, and includes transport by ambulance. You cannot be penalized for going out-of-network or for not having prior authorization.
  3. Hospitalization (Treatment in the hospital for inpatient care). Care you receive as a hospital patient, including care from doctors, nurses and other hospital staff, laboratory and other tests, medications you receive during your hospital stay, and room and board. Hospitalization coverage also includes surgeries, transplants and care received in a skilled nursing facility, such as a nursing home that specializes in the care of the elderly (note: some plans may limit skilled nursing facility coverage to no more than 45 days).
  4. Maternity and newborn care. Care that women receive during pregnancy (prenatal care), throughout labor, delivery and post-delivery, and care for newborn babies.
  5. Mental health services and addiction treatment. Inpatient and outpatient care provided to evaluate, diagnose and treat a mental health condition or substance abuse disorder . This includes behavioral health treatment, counseling, and psychotherapy. (note: some plans may limit coverage to 20 days each year. Limits must comply with state or federal parity laws.
  6. Prescription drugs. Medications that are prescribed by a doctor to treat an illness or condition. Examples include prescription antibiotics to treat an infection or medication used to treat an ongoing condition, such as high cholesterol. At least one prescription drug must be covered for each category and classification of federally approved drugs, however limitations do apply. Some prescription drugs can be excluded. "Over the counter" drugs are usually not covered even if a doctor writes you a prescription for them. Insurers may limit drugs they will cover, covering only generic versions of drugs where generics are available. Some medicines are excluded where a cheaper equally effective medicine is available, or the insurer may impose "Step" requirements (expensive drugs can only be prescribed if doctor has tried a cheaper alternative and found that it was not effective). Some expensive drugs will need special approval.
  7. Rehabilitative services and devices – Rehabilitative services (help recovering skills, like speech therapy after a stroke) and habilitative services (help developing skills, like speech therapy for children) and devices to help you gain or recover mental and physical skills lost to injury, disability or a chronic condition (this also includes devices needed for "habilitative reasons"). Plans have to provide 30 visits each year for either physical or occupational therapy, or visits to the chiropractor. Plans must also cover 30 visits for speech therapy as well as 30 visits for cardiac or pulmonary rehab.
  8. Laboratory services. Testing provided to help a doctor diagnose an injury, illness or condition, or to monitor the effectiveness of a particular treatment. Some preventive screenings, such as breast cancer screenings and prostrate exams, are provided free of charge.
  9. Preventive services, wellness services, and chronic disease treatment. This includes counseling, preventive care, such as physicals, immunizations and screenings, like cancer screenings, designed to prevent or detect certain medical conditions. Also, care for chronic conditions, such as asthma and diabetes. (note: please see our full list of Preventive services for details on which services are covered.)
  10. Pediatric services. Care provided to infants and children, including well-child visits and recommended vaccines and immunizations. Dental and vision care must be offered to children younger than 19. This includes two routine dental exams, an eye exam and corrective lenses each year.

While all qualified plans must offer the ten essential benefits, the scope and quantity of services offered under each category can vary. Each qualified plan must offer essential health benefits which overall are equal to the scope of benefits typically covered by employers, as shown by a Department of Labor survey of employer-sponsored coverage. (Ref: ACA, Section 1302 (b) (2) (a))

Read SEC. 1302. ESSENTIAL HEALTH BENEFITS REQUIREMENTS of the Affordable Care Act for yourself. You can also check out the official rules for Essential Health Benefits which defines how included benefits will work as this was not included in the law itself.


When Do Essential Health Benefits Start?



Under the Affordable Care Act Essential Benefits are offered on all qualifying plans starting January 1st, 2014.

Who Has Access to Essential Health Benefits?

All plans sold in individual and small group markets, including plans sold on and off the Health Insurance Marketplace, and Government healthcare plans like Medicaid and Medicare all include at least 10 Essential Benefits. Grandfathered plans from before the law was enacted in March 23, 2010, plans that will be discontinued in 2015 (2014 in some States), self-funded ASO (administrative services organization) plans, and large group plans don't have to offer Essential Benefits.

• In older plans, not offering these benefits can translate to lower premium costs (because they offer less benefits)

• Large group plans almost all already offer essential health benefits or their equivalent.

• All new Medicaid and Medicare plans must offer essential health benefits starting in 2014.

• Specific health care benefits may vary by state. Even within the same state, there can be small differences between health insurance plans

What Do Essential Benefits Cost?

Some Essential Benefits include no out-of-pocket costs (no cost sharing) and all Essential Benefits offer no annual or lifetime limits and have minimum cost sharing limits.

No Cost Sharing on Some Preventive Services

Essential Health Benefits include annual wellness visits and many types of preventive services including immunizations and screenings at no out of pocket costs. The Affordable Care Act has a major focus on wellness and prevention to help increase early detection and catch sickness before it starts increasing wellness and decreasing the need for costly treatments. (note: For preventive care to have no out-of-pocket expense it must be  delivered by a network provider.)

No Annual Limits on Essential Health Benefits

There are no dollar limits on Essential Benefits. Before annual and lifetime limits over 60% of bankruptcies in the US were medical bankruptcies. Eliminating dollar limits on essential care ensures that patients won't have to stop treatment and/or go broke when they reach their dollar limit.

A Minimum Actuarial Value on All Coverage

There is a cap on out-of-pocket costs on all plans that cover Essential Benefits. Plans offering Essential Benefits must cover at least 60% of covered out-of-pocket expenses and must have reasonable out-of-pocket maximums (in other words a plan offering essential benefits must be at least the equivalent to a "bronze" plan sold on the marketplace.)

Plans must provide one of four levels of benefits, named "Bronze", "Silver", "Gold" and Platinum. Each designation represents an "actuarial value", which is calculated as the average % of total health costs they cover for a defined population). Bronze plans cover 60% on average, "Silver" 70%, "Gold" 80% and "Platinum" 90% of costs on average. For most individuals though a plan will pay far less than these percentages: this is because a high proportion of health care costs are incurred by a small number of very sick people, and once they reach the out-of-pocket maximums, the plan pays 100% of their extra costs.

In general, the higher the metallic level (i.e. Gold and Platinum), the more the plan will pay towards your healthcare expenses, but the higher your monthly premiums will be. Higher tier plans may also offer additional benefits that are not considered "essential".

Out-of-pocket Maximum (Limit)

Your out-of-pocket maximum (limit) is the most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges, or health care your health insurance or plan doesn’t cover. All cost sharing for Essential Benefits counts towards your out-of-pocket limit.

Please note that some plans don’t count your copayments, deductibles, coinsurance payments, out-of-network payments, or other expenses toward this limit. In Medicaid and CHIP, the limit includes premiums. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.

Why Do I Need Essential Health Benefits?

In the past many plans offered sub-par coverage as a way to keep premium costs down. This would seem attractive until one actually needed care. This led to many cases of Americans paying for plans for years and then finding that they did not have access to the care they needed or hit a dollar limit and were denied treatment when they needed it most. Today all plans cover essential health benefits to ensure that we all get the care we need.

Why Do I Have to Pay For Benefits I Don't Need?

While most Essential benefits could be used by anyone, many benefits like Maternity services are included on all plans. One could argue a single male, who never has children, won't benefit from this directly (although it's easy to argue countless ways he benefits indirectly notably his mother, sisters, relatives, community, etc), leading to the obvious question, "why do I have to pay for something I don't need?"

In employment based group health insurance policies, all employees of a company pay the same premium, regardless of their individual health needs. So the premium younger workers pay helps subsidize the higher health costs of older employees. Although this means higher premiums for young employees, when employees get older they will benefit from this arrangement. Similarly male workers will pay premiums that include costs of maternity care and breast cancer, even though they are unlikely to need either. In insurance terms, all members of the group are considered as a "risk pool".

The Affordable Care Act creates a "single risk pool" in the individual and small group markets that mirrors the "risk pools" employees of large firms have enjoyed in the past. This means that regardless of what care you need, or may need, we all share the cost and the risk. This allows insurance companies to cover men at the same rate as women and sick people at the same rate as healthy people. Without a single risk pool insurance would still be unaffordable for many and preexisting conditions would not be covered. Since there is a single risk pool that splits the costs of Essential Benefits all Essential Benefits are offered to all insured.

How Do I Know if My Plan Covers Essential Health Benefits?

If you enrolled in an individual or small group plan after 2014 you most likely have access to Essential Health Benefits that follow the rules of the ACA. The same is true for Medicare and Medicaid.

The ACA contains exceptions for "grandfathered" plans, . These are plans that existed prior to the Act - March 23, 2010, provided that they have not changed significantly. Unfortunately most insurance plans change "significantly" almost every year, so few plans are "grandfathered".There are also special exceptions for self-insured groups, and student health plans. In addition both large employer group plans, and now individual plans, have been allowed to continue until 2015 unchanged.

Exceptions and Limits on Essential Health Benefits

There are some exceptions and limits on Essential Benefits, they are:

• Insurance companies can still put a yearly dollar limit and a lifetime dollar limit on spending for health care services that are not considered essential health benefits.

• Some health insurance plans may have received a temporary waiver from the rules on yearly dollar limits. Yearly limit waivers end with plan or policy years beginning in 2015 (2014 in some States).

• All non-grandfathered health plan must limit the total out-of-pocket costs enrollees pay for in-network.

• Health plans can still however set limits on the number of times you can receive a certain treatment.

• Large Group markets and self funded (ASOs) don't need to offer Essential Benefits.

Essential Benefits Facts

Here are some quick facts about Essential Health Benefits and the Affordable Care Act (ObamaCare):

• Cost sharing on Essential Health Benefits count towards your maximums.

• Aside from the Essential Health Benefits, plans may offer a number of additional benefits.

• Some plans may offer better cost sharing options on benefits subject to out-of-pocket cost sharing. In general the more "valuable" the metal, the higher the percentage of out-of-pocket costs covered by your insurer.

• Essential Health Benefits include the most commonly used health services like preventive services and annual wellness visits with no cost sharing.

• Essential Health Benefits include preventions and treatments you need if you get sick. This includes ongoing treatment for common serious sicknesses like cancer.

• There are no annual or lifetime limits on Essential Health Benefits. Before the ACA over 60% of all bankruptcies in the US were medical related, many due to the cost of treatment exceeding annual and lifetime dollar limits.

• The annual cost to society of substance use disorders alone is approximately $200 billion, yet only a fraction ($15 billion) is spent on treatment. The inclusion of mental health and substance use disorders services is projected to balance these numbers and reduce healthcare costs.

• Instead Essential Benefits, large employers only have to offer "Minimum Essential Coverage" without the act really defining what this is. This has caused some companies to adopt "skinny plans" with very limited coverage. There are no limits on out-of-pocket cost for services not covered! See http://www.kaiserhealthnews.org/Stories/2013/August/26/essential-benefits-bare-bones-health-insurance.aspx

Essential Benefits Myths

Here are some common myths about Essential Health Benefits and the Affordable Care Act (ObamaCare):

 There are no dollar limits on healthcare. Dollar limits still apply to non-essential treatments, essential benefits are covered at no dollar limits and must have reasonable out-of-pocket maximums.

 All Essential Benefits are "free". Only some preventive services have no out-of-pocket expenses. Other benefits may have reduced, or no, out-of-pocket expenses depending on the plan. Even a "free" service still comes with the cost of your monthly premium. See a list of all required "free" Preventive services.

• Abortions have to be provided on demand at public cost. False! The ACA Sect 1303 explicitly prohibits abortion from coverage as an "essential benefit" and confirms existing Federal and State prohibitions on use of public funds for abortion services. Insurers may voluntarily decide to include abortions in their plans: some plans only cover abortion services only in cases of life endangerment, rape, and incest. States who are providing their own health insurance marketplaces, prohibit coverage of abortion services. So far Arizona, Louisiana, Mississippi, Missouri, and Tennessee have banned coverage of abortions. The bans in Louisiana and Tennessee do not contain any exceptions. Missouri only allows coverage where a woman’s life is endangered, Arizona has a life and narrow health exception,and Mississippi allows coverage where a woman’s life is endangered or the pregnancy is the result of rape or incest. In addition – Idaho, Oklahoma, Kentucky, Missouri and North Dakota already ban health insurance companies from covering abortion except by optional rider. If an insurer offers abortion in cases other than life endangerment, rape or incest, then it must separate the cost of such coverage and charge a separate premium for such coverage. Seehttp://www.dpc.senate.gov/healthreformbill/healthbill18.pdf

 Paying for care I don't need means higher premiums. This isn't a myth as much as a misunderstanding of how the law works. In order to make insurance affordable for all Americans a "single risk pool" is created. Since the risk is shared by all insurers, premium prices reflect not only the risk, but all benefits, rights, and protections offered by the Affordable care Act. The only way to provide affordable health insurance for the sick, is for the healthy to share the cost: after all you might become sick and need that help tomorrow, or next year, or in ten years time. This is the way employer group plans work. However, unlike employer group plans, marketplace plans for individuals allow a lower premiums for younger members, while limiting the maximum premium paid by the elderly to three times the premium for a young person. The only way to offer specific care to specific people for specific prices, would be to eliminate the ban on imposing annual and lifetime limits, the ban on gender and health discrimination, and the ban on denying coverage and treatment to people with preexisting conditions. As it stands now many people will pay less than they did before the law due to the aforementioned bans and subsidies, while many will pay more due to the way the new system works. Regardless all Americans buying new plans will have better benefits, rights, and protections on equivalent plans.


Unofficial Resources on Essential Health Benefits:http://www.forbes.com/sites/investopedia/2013/10/11/essential-health-benefits-under-the-affordable-care-act/ - https://www.healthcare.gov/blog/10-health-care-benefits-covered-in-the-health-insurance-marketplace/ - http://lpfch-cshcn.org/publications/issue-briefs/habilitative-services-coverage-for-children-under-the-essential-health-benefit-provisions-of-the-affordable-care-act/